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At least 19 recordsLinked to original sources
PubMed1994

[Effect of ultrasound examination on fetal version of breech presentation].

External version was attempted in 70 pregnancies with foetuses in breech presentation near term. Version was successful in 50 patients (71%), 40 of whom delivered vaginally (80%). Of the 20 patients in whom version was not successful, only 7 patients (35%) delivered vaginally. 2 patients required immediate Caesarean section after attempted version because of ominous foetal heart rate patterns. We analysed the sonographic parameters associated with successful version. The location of the placenta, amount of amniotic fluid, foetal biometry (estimated foetal weight, cephalic circumference, abdominal diameter, femur length) and extension or flexion of the foetal head were analysed. Only extended legs correlated with the success of the procedure. The results suggest, that ultrasonography is an important prerequisite for successful version of a foetus in breech presentation near term.

Adult↗
PubMed1993

[External fetal version from breech to vertex presentation. Evaluation of 1,000 cases].

Results of 1000 external versions of foetuses from breech to vertex presentation under tocolysis were evaluated. The rate of success of the versions was 52%. The success rate improved with gestational age, with increasing parity, with increasing age of the mother and her increasing body weight. The location of the placenta did not play a decisive role. The success rate of the version was remarkably good, even, in cases with small-for-gestational age foetuses and large-for-gestational age foetuses as well as in cases with a previous Caesarean section. The frequency of typical complications and the resulting Caesarean rate of 2.3% are within the acceptable limit. Up to now, from a total of more than 1,500 versions performed at the Department of Obstetrics at the Women's Hospital, Berlin-Neukölln, no death of either mother or child has occurred, which could be related to this procedure. Of course, the prerequisite for a safe version is strict adherence to the essential guidelines. The fact, that versions are not practised in all obstetrical departments, is partly due to the embarrassing lack of expert knowledge on the part of some practitioners and clinicians. In numerous cases, a moderately difficult laparotomy--which Caesarean section is in principle--with all the inevitable risks and dangers, could have been prevented, if a version had been performed.

Adult↗
PubMedDate not supplied

[Influences on decisions of pregnant patients with breech presentation for external fetal version or cesarean section--information status and anxiety pattern].

Within the framework of a retrospective and prospective analysis of 61 women with breech presentation in late pregnancy and with the help of a half-standardised questionnaire, we investigated the subjective reaction of these patients after they had been informed of their situation, as to what fears resulted and how well informed they were regarding the various obstetrical procedures in cases with breech presentation. The patients in the version group were clearly more anxious (n = 41). They were frightened of putting the child's well-being at risk, damaging personal health and having a cesarean section. The fear patterns were very varied in both groups. In the cesarean group (n = 20) the patients were not so afraid of the anesthesia and the risk of infection, whereas those in the version group were considerably more afraid; it was quite the reverse as regards the risk of permanent damage to the child due to the version--in the cesarean group this was rated as a high risk, whereas in the version group it was rated as a slight risk. The decision on the obstetrical procedure was mainly influenced by the doctor. In conclusion it can be said, that too little is known about the obstetrical procedure of cephalic version near to term and that it is tainted with unnecessary fears. We recommend that more intensive, specialised information should be given before undertaking obstetrical management of breech presentation.

Adult↗
PubMed1997

[Criteria for successful outcome of external fetal version from breech presentation to cephalic presentation].

The technique of external version of breech presentations has been proposed as a tool to reduce morbidity of fetus and mother. 79 cases of a 3 year period were evaluated aiming at identification of risk factors improving the success rate of the intervention. A total of 48% of attempts was successful. The most frustrating single factor was identified to be the oligohydramnion. Posterior implantation of the placenta improved the rate to 61%. The umbilical cord being localized by coloured Doppler had little influence even if positioned around the neck as neither success nor complications were predictable in this case. Maternal adipositas had a negative influence on the success rate. Perinatal morbidity war not increased in the group of external versions.

Breech Presentation↗
PubMed1998

[External fetal version from breech presentation to cephalic presentation: modifying factors, reliability and risks].

External cephalic version (ECV) was performed in 524 single pregnancies. The version was successful in 38.4%. Success is mainly influenced by parity, quantity of amniotic fluid and maternal weight. An emergency cesarean section was necessary in 0.6% because of fetal bradycardia. Compared to controls the ECV was not associated with the increase of a premature rupture of membranes, complications with umbilical cord or transfer of the child to the paediatric department. Also there was no difference in the pH or Apgar-ranges. One fetal death was diagnosed 17 days after ECV, the reason therefore remained unclear. There are existing a few other reports with similar cases. We conclude that ECV is a appropriate trial to convert the fetus into cephalic presentation, but because of possible complications precautions must be taken, e.g. that means to carry out the trial under conditions which allow immediate cesarean section and a frequent follow up of the woman until delivery.

Adult↗
PubMed1996

[Fetal version as ambulatory intervention].

The external cephalic version (ECV) of the fetus at term reduces the maternal and fetal risks of intrapartum breech presentation and Caesarean delivery. Since 1986 over 800 external cephalic versions were performed in the outpatient Department of Obstetrics and Gynaecology of the Städtische Frauenklinik Stuttgart. 60.5% were successful. NO severe complications occurred. Sufficient amniotic fluid as well as the mobility of the fetal breech is a major criterion for the success of the ECV. Management requires a safe technique for mother and fetus. This includes ultrasonography, elektronic fetal monitoring and the ability to perform immediate caesarean delivery as well as the performance of ECV without analgesicas and sedatives. More than 70% of the ECV were successful without tocolysis. In unsuccessful cases the additional use of tocolysis improves the success rate only slightly. Therefore routine use of tocolysis does not appear necessary. External cephalic version can be recommended as an outpatient treatment without tocolysis.

Adult↗
PubMed1977

Value of external version in fetal malpresentation in combination with use of ultrasound.

During 1969--1974 six hundred and forty-nine external versions were attempted during the last trimester on 491 mothers with fetal malpresentation. The procedure was monitored with ultrasound in 1969--1974. Most of attempts (70.0%) were made during the 32nd-36th weeks. The final version rate after one or more attempt was 76.2%, being lower (67.0%) in nulliparous than parous women (84.6%). The incidence of breech presentation at birth decreased from 4.5 to 2.9% (p less than 0.001). The most serious complication was one premature labor but the infant survived. The perinatal mortality was 2.0% and, after excluding abnormal infants, 0.8%. The combination of external version and the use of ultrasound is a safe method which avoids hazardous vaginal breech delivery and is recommended in obstetric practice.

Apgar Score↗
PubMed2004

External cephalic version induced fetal cerebral and umbilical blood flow changes are related to the amount of pressure exerted.

OBJECTIVE: To correlate the applied pressure during external cephalic version with the changes in fetal middle cerebral arterial and umbilical arterial flow before and after the procedure. DESIGN: A prospective observational study over a two-year period. SETTING: External cephalic version was performed in a university hospital. POPULATION: Sixty-nine women with singleton breech-presenting pregnancy at or above 36 weeks of gestation undergoing external cephalic version. METHODS: During external cephalic version, the operator wore a pair of pressure-sensing gloves which had thin piezo-resistive sensors positioned on the palmar surface. During each version procedure, real-time pressure readings were recorded from all sensors, and then analysed with a computer program. The amount of pressure applied over time was presented by pressure-time integral. The pulsatility indices of both fetal middle cerebral artery and umbilical artery before and after external cephalic version were measured. The changes of pulsatility indices of both middle cerebral artery and umbilical artery were presented as a ratio of the post-external cephalic version pulsatility indices to pre-external cephalic version pulsatility indices, denoted by middle cerebral artery pulsatility index ratio and umbilical artery pulsatility index ratio, respectively. The statistical correlation between pressure-time integral and middle cerebral artery pulsatility index ratio and umbilical artery pulsatility index ratio are analysed using Pearson's correlation test. MAIN OUTCOME MEASURES: Changes in pulsatility indices of fetal middle cerebral and umbilical arteries and fetal heart rate after external cephalic version. RESULTS: The overall success rate of external cephalic version was 77%. There was a significant negative correlation between pressure-time integral and both middle cerebral artery pulsatility index ratio (P= 0.001) and umbilical artery pulsatility index ratio (P= 0.012). When women were categorised according to placental site, pressure-time integral was negatively correlated with middle cerebral artery pulsatility index ratio only when the placenta was posteriorly located (P= 0.003), and with umbilical artery pulsatility index ratio only when the placenta was laterally located (P= 0.03). CONCLUSIONS: The greater the force applied during external cephalic version, the greater the reduction in pulsatility indices of middle cerebral artery and umbilical artery, indicating an increase in blood flow through these arteries. The increase in cerebral blood flow after external cephalic version is more prominent when the placenta is lying posteriorly, while the increase in umbilical flow is more prominent when the placenta is lying laterally. These findings suggest that the vascular changes probably represent a direct effect of force exerted on the fetal head and the placenta.

Adolescent↗
PubMed2006

Prediction of intrapartum Cesarean delivery for non-reassuring fetal status after a successful external cephalic version by a low pre-version pulsatility index of the fetal middle cerebral artery.

OBJECTIVE: To determine whether a pre-version Doppler assessment of fetal cerebral and umbilical blood flow can predict the ultimate need for intrapartum Cesarean delivery after a successful external cephalic version (ECV). METHODS: A prospective observational study on women undergoing ECV between 36 and 38 gestational weeks was performed over a 5-year period. The pulsatility index (PI) of the fetal middle cerebral artery (MCA) and umbilical artery, heart rate and amniotic fluid index were measured before ECV. Women who had successful ECV were then divided into three groups according to the mode of delivery: (1) vaginal delivery, (2) intrapartum Cesarean delivery for poor progress and (3) intrapartum Cesarean delivery for non-reassuring fetal status. The fetal blood flow parameters were compared between the groups. Potential predictors were further analyzed using receiver-operating characteristics curves. RESULTS: Of 174 women with successful ECV, 140 (80.5%) had vaginal delivery, 19 (10.9%) required emergency intrapartum Cesarean delivery for non-reassuring fetal status and 15 (8.6%) for poor progress. MCA-PI was significantly lower in the group with non-reassuring fetal status. MCA-PI is predictive of intrapartum Cesarean delivery (area under the curve = 0.68, P = 0.021). The sensitivity and specificity at a cut-off level of 1.4 were 62.5% and 76%, respectively, while at a cut-off level of 1.5 they were 68.8% and 63.5%, respectively. CONCLUSION: Intrapartum Cesarean delivery for non-reassuring fetal status after successful ECV is associated with a lower pre-version fetal MCA-PI.

Breech Presentation↗
PubMed1990

An altered IGF-I receptor is present in human leukemic cells.

We have characterized and analyzed IGF-I- and insulin-stimulated cell growth, receptor binding, and autophosphorylation in the human leukemic cell line HL-60. IGF-I-stimulated cell growth occurred at low (5 ng/ml) and insulin stimulated only at high (500 ng/ml) concentrations. Binding of 125I-IGF-I to partially purified plasma membrane proteins followed the characteristics of IGF-I receptor binding. 125I-IGF-I binding, as determined by chemical cross-linking, occurred to a 145-kDa protein. IGF-I, as well as insulin, stimulated the autophosphorylation of a 105-kDa band (pp105), but we could not detect a 95-kDa band corresponding to the known molecular mass of the IGF-I and insulin receptor beta-subunits. Phosphorylation of pp105 followed the dose-response characteristics of the IGF-I receptor. The phosphorylation of pp105 occurred at tyrosine and threonine, and the pattern of HPLC tryptic peptide maps showed marked differences when compared with that of a phosphorylated insulin receptor beta-subunit. Enzymatic deglycosylation of pp105 resulted only in a slight reduction of the molecular weight. These data suggest that pp105 is the beta-subunit of an IGF-I receptor variant with a higher molecular weight, similar to that found in fetal tissue. The HL-60 cell may acquire, at least in part, malignant growth characteristics through reexpression of the fetal version of the IGF-I receptor.

Cell Division↗